Associations between high‐intensity zones, endplate, and Modic changes and their effect on T2‐mapping with and without spinal load

Abstract

The purpose was to investigate if high intensity zones (HIZ), Modic (MC), and endplate changes (EPC) display different behaviors measured with quantitative magnetic resonance imaging (MRI) with and without loading of the spine and if there is a simultaneous presence of these features in the same motion segment. 130 motion segments in patients with chronic low back pain (n = 26, 25-69 year, mean 38 year, 11 males) were examined. HIZs, MCs, and EPCs (i.e., structural findings, reflecting calcifications, erosions, and fissures) were determined with standardized MRI. Different T2-values with and without loading for these features were then determined with the quantitative MRI method T2-mapping. Significantly different behaviors were found in the spinal tissues with associated HIZs, MC, and EPC (p < 0.004). HIZ (62% of patients, 1-2/patient) was associated with EPC (100% of patients, 1-7/patient) (p = 0.0003 and 0.0004 for upper and lower EPs), with an occurrence of 91% for upper and 71% for lower endplates adjacent to discs with HIZ. MC (81% of patients, 1-3/patient) were associated with EPC (p < 0.0001) with an occurrence of 87% for endplates adjacent to vertebrae with MC. The occurrence of both HIZ and MC was 43% (p = 0.0001) for upper and 29% (p = 0.003) for lower vertebrae. HIZ was associated with simultaneous presence of both MC and EPC in the same motion segment. T2-mapping was found to objectively reflect changes in the spinal tissues associated with HIZs, MC, and EPC.

Loading of the Spine in Low Back Pain Patients Does Not Induce MRI Changes in Modic Lesions: A Prospective Clinical Study

“…However, no load-induced difference could be shown when stratifying for MC type. This study confirms the findings of Lagerstrand et al, who reported no load-induced changes in vertebrae with MCs using T2 mapping and segmentation of the entire vertebrae [ 20 ]. Our results thus contradict the findings of Splendiani et al, who reported that an increased MC area correlated with increased pain in the upright position [ 15 ], suggesting a possible diagnostic value in exploring this dynamic MC component in patients with LBP.…”

“…Theoretically, even within a certain type, MCs might represent different phenotypes; depending on the type of endplate change (sclerosis versus cracks/fissures), some may be differently affected by load. For example, it has been reported that load-induced T2-relaxation time differs between endplates with and without apparent changes [ 18 , 20 ]. The lack of correlation between induced change in MC volume and SI, however, makes this less likely, especially since the analyses were repeated with similar results after excluding MCs without change in volume.…”

“…The few existing such studies have segmented the entire vertebrae and used T2-mapping, whereas in the current study, the entire MC was segmented. For example, Lagerstrand et al reported a lack of significant load-induced signal change in vertebrae in both patients and controls [ 17 ], while another study reported different load-induced behavior between vertebra with and without endplate changes [ 20 ]. Present findings contribute to the understanding of MCs and demonstrate their insensitivity to different loading conditions.…”

“…Several studies have also reported that MRIs might display different tissue characteristics when conducted during spinal loading than when performed in the conventional relaxed supine position [ 16 , 17 , 18 , 19 , 20 , 21 , 22 ]. For example, MRI performed during spinal loading instantaneously display dynamic behaviors in both intervertebral discs, vertebras and endplates, indicating between-group differences in tissue characteristics in LBP patients and controls that could contribute to linking image-based features to pain [ 17 , 19 ].…”

Assessment of the correlation between clinical and radiological outcomes in patients suffering from mild to moderate cervical spine dysfunction symptoms: a prospective study

“…Location of the Modic changes in relation to endplate was recorded as entire, central, anterior, or posterior. The HIZ was defined as a bright white signal on T2‐weighted MR images, located in the posterior annulus fibrosus of the intervertebral disc [ 25 , 26 ]. Also, Cobb angle was drawn on T2-weighted sagittal view MR image to evaluate the state of the cervical curves [ 27 ], which was defined as the angle between a line parallel to the base of C2 and the line parallel to the base of C7.…”